Hearing loss explained
If I had known that hearing loss wasn’t just that you either hear everything or you hear nothing, if someone had told me that hearing loss is different for everybody…things would’ve been much better. I would have felt more comfortable and got my hearing checked earlier. It would’ve prevented years of not knowing what was going on or who to turn to. Just access to basic education, basic knowledge
– Sarah
The main parts of the ear:
Types of hearing loss
Even from a simple diagram like this, you can appreciate that our hearing system is made up of many different parts.
For someone to hear well, the sound needs to travel down the ear canal towards the eardrum. The eardrum needs to be able to vibrate (shake) freely in response to the sound so that it can send the sound vibration through to the three tiny middle ear bones behind it. The middle ear bones then need to move freely to pass the vibration along to the fluid-filled chambers of the cochlea.
In the cochlea, the fluid vibration moves tiny structures called stereocilia. These structures sit on top of special hair cells within the cochlea. The movement of the stereocilia is what allows us to detect different pitches (tones) of incoming sound. The nerves attached the hair cells then send the signal to the brain to be processed. All of these parts are required to hear well, and when any one of these structures doesn’t work well, we may experience a hearing problem.
Conductive hearing loss
A person might have a problem with the ear canal, or the eardrum, the middle ear space, or the bones in the middle ear. The type of hearing loss that results from problems in these parts of the ear is called a conductive hearing loss because the structures required to conduct (send) the sound energy into the inner ear are not working well.
For people with a conductive hearing loss, the main problem is one of volume, or loudness, of the speech signal. Hearing aids are particularly helpful for people with a conductive hearing loss because hearing aids amplify sounds – they boost the volume – and that’s really exactly what somebody with a conductive hearing loss needs.
Sensorineural hearing loss
A person might have a problem with the cochlea or the nerve of hearing, which sends information to the brain for processing. The type of hearing loss that results from problems in these parts of the ear is called a sensorineural hearing loss because the sensory parts or the nerve (neural) parts of the ear are not working well. People with a sensorineural hearing loss have a problem with both volume and clarity.
Mixed hearing loss
Sometimes people have more than one problem in their hearing system, or one pathology that affects both the middle ear and the inner ear, and those kinds of complicated hearing losses are called mixed hearing losses.
Causes of hearing loss
There are many things that can damage our hearing. Conductive hearing loss may result from fluid in the middle ear spaces, damage to the eardrum, allergies resulting in inflammation in the middle ear spaces, or a stiffening of the middle ear bones. Sometimes conductive hearing losses can be treated medically, and hearing can be restored. For example, if there is impacted earwax (earwax build-up against the ear drum), it’s usually possible to remove this and the hearing improves.
Ageing, noise exposure, the side effects of drugs or even tumours can damage the hair cells in the cochlea or the nerve of hearing, and result in a sensorineural hearing loss. Some health conditions like heart-related conditions, certain conditions of the immune system, or diabetes can also cause a sensorineural hearing loss. These types of losses are permanent, because the delicate hair cells of the cochlea can’t be replaced once they are destroyed.
If you have any further questions about how hearing works generally, or about your hearing condition specifically, ask your GP or audiologist for some more information.
What are the signs of hearing loss?
Hearing loss is one of the most common health conditions, affecting one-in-six Australians. The rate rises among older Australians – nearly three out of four people over the age of 70 have hearing loss.
You might not realise you have hearing loss, because it is invisible. This means you can’t see hearing loss in another person. However, you can see signs of it. A person with a hearing loss may show the following signs:
- Asks for repeats or clarification frequently
- Mishears detail
- Answers incorrectly or unexpectedly
- Conversation dominance/avoidance
- Difficulty hearing in noisy environments
- Avoidance of group discussion
- Frustration or fatigue
Our hearing for high pitched sounds is more sensitive to the effects of ageing and noise damage. An example of a high-pitched sound is the voice of a young child. Low pitch is a deeper sound, like a man’s voice. Words have high- and low-pitch sounds in them. People with hearing loss often find that they can hear the low-pitch, deeper sounds in words, but miss the high-pitch sounds. When that happens, people miss the meaning of the words because they only hear parts of them. If you lose your hearing for high-pitch sounds, conversations can sound like people are mumbling or not speaking clearly. Just turning the volume (sound) up is often not helpful for people with this kind of hearing loss, because volume alone doesn’t solve the problem. It would be like turning up the brightness in a blurry picture. The picture is still blurry, but brighter.
You might find that higher pitched voices, namely women’s voices and children’s voices, are harder to understand.
You might have stopped hearing high pitched nature noises like birds chirping
You might struggle with hearing the high pitched consonants like ‘s’ and ‘f’ and ‘th’.
You might have a sense of the problem being not so much about volume, but about clarity – you can hear people, you just can’t always understand them..
You might find people often accuse you of having ‘selective hearing’ because your hearing for some sounds is ok, but not for others
You might find that it sounds to you like everybody is ‘mumbling’ when they speak
You might find that you need to turn the volume of the TV or radio up louder than others in order to hear
If you suspect you may have a hearing loss, or you suspect someone you care about may have a hearing loss, a good first step is to perform a do-it-yourself hearing screening test.
HEARING SELF-SCREENING TOOLS
If you want to check your own hearing, there is a web-based hearing screening tool from Hearing Australia. Alternatively, you can use the mobile application hearing screening tool from the World Health Organisation, hearWHO.
What are the impacts of hearing conditions?
The impacts of living with a hearing condition touch on:
– A person’s quality of life
– Their social life and relationships
– Their mental and emotional health
– Their overall physical health
Social life and relationships
Social withdrawal means a person feels less connected and less socially active, and it can result in a loss or reduction in social skills. Hearing loss can lead to social withdrawal. It may cause a loss of enjoyment from being with others, and it has a huge impact on relationships. Hearing loss can reduce a person’s social networks, both personal and professional.
Mental and emotional health
Hearing conditions can have a major effect on mental and emotional health too. People with hearing loss and/or tinnitus are more likely to be depressed, lonely or anxious.
Hearing loss can lead to frustration and low mood because of constantly having to ask people to repeat what they’ve said. It can lead to fatigue (being tired) due to increased ‘listening effort’ and the need to concentrate harder on what others are saying.
There is evidence to show that hearing loss increases the risk of cognitive decline. This means a person may not be as ‘sharp thinking’ as they used to be. Work and school performance can suffer too, if appropriate supports are not put in place.
Social
stigma
There is also the social stigma to deal with — denial, embarrassment, and poor self-esteem. There are also other people’s perceptions of the person with hearing loss’s mental sharpness. Studies show that many people with hearing conditions have negative feelings about their hearing, such as feeling ashamed to admit it to other people. Many people know about their hearing loss for many years before finally reaching out for help. People put it off for a long time.
So, you can see that there are many consequences of hearing loss, which go well beyond the actual inability to hear certain sounds.
Why are there such wide-reaching impacts?
Hearing is essential to the most common forms of communication. Communication is essential to our ability to live as social creatures, connecting with others around us. Our primary means of communicating with others in our society is via language, through talking and listening. If that process is disrupted, and if we don’t have other means of communicating fluently with others (for example, sign language) then that disconnect can have major impacts on our lives.
Lived experiences
You may find value in reading real-life stories from a variety of people living with hearing conditions – how they manage their hearing condition day-by-day, how it affects them, how they sought help for their hearing condition and the outcome of their help-seeking efforts.
Communication tips
Environmental strategies
If you have a hearing condition or live with somebody who does, there are some simple things you can do to the living and dining areas of your home that can make socialising a little easier.
Buffer the sound of the room. Fabric absorbs sound and reduces echoes. Carpeted floors, soft furnishings, tablecloths, and drapes will allow for a quieter and more accessible setting than hard floors, bare surfaces and uncovered windows.
Check your lighting. People who lip-read need good lighting to see other people’s faces clearly so make sure your rooms are clearly lit.
Go full-circle. Circular tables create a better listening environment and allow people with hearing conditions to lip-read more easily so opt for a circular table in your dining room, and ask if a circular seating arrangement is possible if you are dining out.
Find your quiet place. Identify a quiet part of the house where you can retreat to if you need a listening break; this is also helpful for people who can experience sensory overload.
Turn down the music. While music adds a nice tone to any occasion, it can become overpowering to people with hearing conditions. The effort in trying to catch people’s words over the background music can be exhausting, so make sure music levels are low. If you are struggling to hear, ask the host to turn the music down a notch.
Location, location, location. Try to sit with your back to the wall and with a light behind you. This will improve acoustics and allow you to lip-read more easily.
Choose a buddy. If you are going to an important social event like an engagement party or a Christmas party, having someone that you can talk to one-on-one on the day and can help you catch words you may have missed can go a long way in making you feel included. Ask a person to be your buddy in advance so you can have peace of mind on the day.
Take it outside. If you’re in the middle of a one-on-one conversation and are struggling to hear, ask the person you’re speaking with to go to a quieter place with you.
You can use similar approaches when socialising outside the home – taking note of your environment, selecting your seating carefully and even thinking ahead about where you plan to go (for example, is the place likely to be noisy or is it a small and quiet setting) can go a long way towards making listening a little easier.
Self-advocacy, finding support
As a person with hearing loss, advocating for your needs can be challenging, particularly if your hearing condition is new. It takes practice, and confidence, and these build over time. In the meantime, if you need a little help advocating for yourself – in the workplace, with your social groups, or even at home – there are some advocacy groups that can provide tips and advice, such as Deafness Forum of Australia and Deaf Australia.
Where can I go to check my hearing?
Getting a hearing test is the best way to confirm if a hearing loss exists. A hearing test is also useful to help your doctor medically manage the cause of your hearing loss and will be useful for a hearing healthcare clinician to guide you on what options may be relevant to you.
Oftentimes people start by consulting with their GP, and then the GP might refer that person to an audiologist or audiometrist for a comprehensive assessment of their hearing. However, you don’t need a GP referral to make an appointment with either an audiologist or an audiometrist.
What is an audiologist?
Audiologists are allied health professionals who work with people of all ages – from infants to older adults. They work with people with complex needs to preserve, manage and improve their hearing. Audiologists also work with people who need to improve their ability to process and understand sounds, and improve their balance. They can assess hearing and functions associated with hearing, such as the nerve function and sound processing function. They can also assess other conditions related to ear problems such as vestibular (balance) function and tinnitus (ringing in the ears). They do these assessments by performing tests. Audiologists provide rehabilitation as well as communication training, counselling and the prescription and fitting of devices. Audiologists have the equivalent of an Australian University Master’s Degree in Clinical Audiology. Full membership with Audiology Australia and certification as an Audiology Australia Accredited Audiologist ensures that your audiologist is bound by a Code of Conduct and committed to ongoing professional development requirements. You can find a trusted audiologist in an area near you by visiting Audiology Australia.
What is an audiometrist?
Audiometrists in Australia primarily work with adult clients (including older adults) and provide a range of services to school-aged children. They focus on hearing and auditory (hearing) function assessment. They also provide rehabilitation by applying a range of diagnostic tests and approaches. These approaches include counselling and the prescription and fitting of non-implantable devices. Audiometrists may also provide rehabilitation for tinnitus using education and hearing devices. They have a Diploma in Audiometry or a Bachelor of Audiometry Degree from an Australian University or international equivalent, ordinary membership with the Australian College of Audiology with competency in hearing aid dispensary.
How do I find an audiologist/audiometrist?
You may access these professionals in a range of settings including public or private hospitals and community health centres or in private clinics. To find a service you could ask your GP, or read the online reviews for the selected clinic or audiologist to see if they receive good feedback from clients. Word of mouth is also another way to confidently find someone you trust.
Costs
Costs for hearing assessments vary, and in some cases may be covered by Medicare, be bundled into the cost of a hearing aid fitting, or require out of pocket fees. Some clinics offer free hearing tests – it is worth asking at the time of making your appointment. See our resource called ‘What funding support am I eligible for?’ for more information.
What funding supports am I eligible for?
When it comes to hearing healthcare, there are many funding options available. These depend on many factors, including: the cause of the hearing condition; the referral pathway; the healthcare professionals or clinics involved; and whether devices or other treatments are needed. As there are many sources of funding, it can sometimes be difficult to know which is the best option. If you need more advice, talk to your GP or audiologist. Ask lots of questions. Remember, if your provider doesn’t offer a funding scheme you are eligible for, you can always go elsewhere.
Some hearing conditions require medical treatment, possibly including a referral from your GP to a specialist. If this is the case, your medical treatment and related diagnostic hearing tests may be covered by Medicare and/or private health insurance. If your hearing healthcare journey involves hearing aids or other assistive technologies, there are a number of funding pathways that you may be eligible for.
Hearing Services Program
The largest public funding source is the Australian Government’s Hearing Services Program (HSP). The aim of the HSP is to help people with hearing loss to improve their quality of life. HSP also works to reduce the consequences of hearing loss by helping with access to high-quality hearing services and assistive devices.
Through this program, people who are eligible pension concession card holders can receive subsidised services. These services include counselling and the fitting of hearing device(s). Program services are delivered through two streams:
- The Voucher stream delivers subsidised hearing services to holders of an Australian Government concession card.
- The Community Service Obligations stream delivers subsidised hearing services to disadvantaged populations (for example, adults with specialist hearing needs; Aboriginal and/or Torres Strait Islander people over the age of 50)
State and Territory Governments
State and Territory governments are important providers of hearing healthcare in Australia. Examples of where services are provided include hospitals, health centres, community care and prisons. Referral to these healthcare services is often via your GP.
Department of Veterans’ Affairs (DVA)
Eligible DVA card holders are also able to access subsidised hearing services, including tinnitus assessment and rehabilitation. There are a few steps involved in obtaining hearing devices from the DVA:
- Make an appointment with an audiologist and discuss your need for hearing aids.
- During the appointment let your audiologist know that you are a DVA card holder. Ask the audiologist to seek approval from the DVA.
- Wait for the approval to come through before you purchase your hearing aids.
National Disability Insurance Scheme (NDIS)
Funding is available through the NDIS to support people with a disability in Australia, including those with profound (severe) hearing loss. Accessing NDIS funding involves six steps:
- Check your eligibility and If you are eligible, contact the NDIA for an Access Request Form online or by calling 1800 800 110.
- Obtain evidence of your hearing impairment (for example, a report from an audiologist).
- Apply for access to the NDIS using the Access Request Form.
- If your access request is successful, an NDIS planner will contact you to make an appointment to develop your NDIS plan.
- Apply for access to the Office of Hearing Services (OHS) Program using the OHS Application for NDIS Participants.
- Make an appointment with your audiologist once access to the OHS is granted and your plan is approved. Your audiologist will then fit your hearing aids/assistive listening devices.
Private options
Some private health insurers cover audiology services and hearing aid devices under their extras products. Contact your private health insurance provider for more information. If private health insurance doesn’t fully cover the cost of the hearing aids, then other private options may help. You may look at accessing some of your superannuation to help cover the cost of your hearing aids, or setting up a payment plan with your hearing clinic.
Some people are fully self-funded, meaning they pay for the entire cost of their hearing aids themselves, or, if they are eligible for funding through the HSP as outlined above, they may have the option of paying extra to obtain a more advanced hearing aid than the standard offering (this is referred to as a ‘top-up’ payment).
Other sources of support
People who are ineligible for the HSP and are unable to afford hearing care may be able to have a hearing aid device fitted at a reduced cost through a hearing aid bank. Hearing aid banks are available in most states and territories, see:
The Telstra Disability Equipment Program is available to people whose hearing affects their ability to use a standard telephone handset.
Job Access – an government organisation providing resources related to employment for people with disability, their employers and service providers – has the Employment Assistance Fund (EAF). This can help cover the cost of assistive and communications technology and Auslan interpreting. Additionally, Job Access can help cover hearing condition awareness training for your colleagues.
If you have sustained a hearing loss due to noise exposure at work you may be entitled to workers’ compensation in the form a payment, or payment for the cost of hearing aids. Specific state legislation applies.
What technology and devices might help me?
First, it is important to talk to your doctor or audiologist to determine whether there may be medical factors that might be adding to your hearing difficulties. If there is wax in your ear canal that is blocking sound from passing through, for example, then this is something that your doctor can attend to. Similarly, if there is any kind of medical condition affecting the health of your middle ears, there may be medical treatments available that can help to improve your hearing. For some ear conditions, there may be surgical options. However, for many hearing conditions, such as age-related sensorineural hearing loss, there is no medical treatment available, and you may need to explore some of the options described below.
Hearing aids
Hearing aids are often the first things that spring to mind when we think about treating hearing conditions. Certainly, hearing aids are a very important component of many treatment plans. Most people with hearing loss can gain benefit from hearing aids. However, they are not an ‘instant fix.’ Hearing aids take time to become accustomed to, particularly if you have lived with a hearing condition for a long time before seeking help. The brain needs time to ‘re-learn’ how things sound through the device, in various listening environments and with various speakers. But given realistic expectations and a little practice, hearing aids can be enormously beneficial to many people with hearing conditions. Hearing aids are not the only solution, however. There are other technological solutions that may help.
Headphones and assistive devices
There are assistive listening devices (often called ALDs) such as headphones that connect directly to your television for personal volume control. If you wear a hearing aid that is fitted with a telecoil, you can make use of audio-induction loop systems that are often installed in auditoriums. These systems enable the wireless audio signal to be delivered directly to your hearing aid for better clarity of sound.
There are still other devices that are used with your hearing aids to make listening in noisy environments a little easier. Your audiologist can help you to decide what might work best for you, depending on your hearing condition, your hobbies and lifestyle, whether you use hearing aids or not, and – of course – your own personal preference.
Cochlear implants
Another type of hearing device is the cochlear implant (or CI). CIs are not for everybody – they are a surgically implanted hearing device and are only recommended for people with more severe types of sensorineural hearing loss. There are currently about 14,000 Australians that have CIs. There are three major CI brands – Cochlear, MED-EL and Advanced Bionics, and their websites contain lots of very good information about the devices. Talk to your GP or audiologist if you would like to know more about a CI.
Closed captions
Closed captions include a written transcription of dialogue in addition to a description of musical cues, sound effects and other relevant audio information. They are very helpful when watching television and streaming services. Online meeting platforms such as Zoom and Microsoft Teams often offer auto-generated captions (or live transcription) services too.
Speech to text software
There are apps available that convert speech to text in real-time for live conversations. They are usually available for Android, iOS, and Windows.
What questions should I ask my GP?
A GP may look in your ears or carry out other physical examinations and review your medical history. From there, they may order additional tests, recommend treatment or connect you with a specialist.
When talking with your doctor, whether GP or specialist, it’s important to let them know about your concerns (and show them the results of your hearing screening test, if you took one).
Have a list of questions prepared, for example, you might like to ask some or all of the following.
What’s going on?
Is there anything in my current or previous history (e.g. health conditions, medications) that could account for the change in my hearing?
Could my family history or my exposure to noise account for my current difficulties (if these factors are relevant)?
Is my condition likely to be stable, or get better or worse over time?
What treatment options are available?
Do you have any written information about my condition?.
Solutions, services and treatments
Do I really need this treatment/service?
How likely is this treatment/service to be successful?
What are the likely benefits and risks from this treatment/service?
Are there simpler or alternative options?
What happens if I don’t do anything? Ask if it might get worse or better if you don’t
What are the costs? Costs can be financial, emotional or a cost of your time. Is there a cheaper or easier alternative?
What is the process of obtaining this treatment/service? For example, how many appointments, for how long?
Are there other services/specialists outside of your clinic that might be useful in my situation?
Can you recommend an audiologist/audiometrist for a full diagnostic assessment of my hearing?
If your GP doesn’t have any particular clinician that they usually recommend, ask friends or family for a recommendation – other people’s experiences can be a great indication of the experience you can expect. Be sure take our fact sheet Questions for Your Audiologist along with you to your first appointment.
“I have a cochlear implant in my left ear and although I have a hearing aid for the right ear I hadn’t been using it until recently. I saw my cochlear implant surgeon for a follow-up and he asked why I wasn’t wearing the hearing aid. It turns out it was because I didn’t hear the initial instructions clearly enough – they were trying to tell me not to wear it for just a little while after the implant surgery to get used to the cochlear implant, but then start wearing it again shortly afterwards. But I thought they meant don’t wear it at all. So for two years I had not been wearing the hearing aid when I should have been, so I was struggling a lot. Since I’ve started to wear it, it’s been a lot better. I should have asked more questions at the time!” – Marjia.
You should feel confident speaking to your doctor. Always ask questions if you are unclear about information and always follow up on your treatments and tests. If you would like another opinion regarding a treatment or medical condition, you should always seek a second opinion from another doctor.
Tips for choosing a hearing healthcare clinician
Hearing healthcare clinicians work in a range of settings including public or private hospitals and community health centres or in private clinics. To find a service, you could ask your GP or read the online reviews for the selected clinic or clinician to see if they receive good client feedback. Word of mouth is another way to confidently find someone you trust. You can also use Audiology Australia’s Find an Audiologist.
A good relationship with your hearing healthcare clinician is imperative to achieving good outcomes. In fact, research suggests that the relationship you have with your clinician makes more difference than the type of hearing aid you get. You should feel confident, understood, supported and empowered by the care you receive. Therefore, when choosing a clinic/clinician you might want to ask some questions to help determine if they are the right fit for you:
Does the clinic/clinician offer the service you are looking for? Some clinics, such as public hospitals, may only provide diagnostic assessments (such as hearing tests), but do not provide rehabilitation (such as communication strategies or device fitting).
Is the clinician qualified? Audiologists and audiometrists have different training levels and scopes of practice.
Are they up to date with their knowledge and will abide by a code of conduct? One way to ensure this is to ask if they are a member of a professional body. For example are they an Audiology Australia accredited audiologist?
Is the clinician receiving a commission from the sale of hearing devices, or any incentives or bonuses? How does that change what they recommend to you?
Are they able to offer devices across a range of manufacturers?
Is the clinic accessible for you?
Is the clinic local and is it easy to get an appointment? You may need ongoing appointments.
Does the clinic offer a range of solutions and services, other than just hearing aids? If they don’t, will they work with you to co-ordinate your care?
Does the clinic have a range of funding options available to you?
Will you have the same clinician each time you visit? Will the clinic provide an interpreter if you need one?
Is it ok if you take a friend or family member along for your appointment? Are they willing to work with them, so they can support you too?
If you are comfortable with the answers to the above questions, congratulations, you have an excellent foundation to building a great therapeutic relationship. If not, you are not obligated to stay with this clinic/clinician. If you don’t understand anything discussed with your audiologist/audiometrist, you are allowed to ask questions or to ask them to explain it in another way. Consider asking to speak with another audiologist at the same clinic, or seek out another clinic in your local area.
What to expect at your first audiology appointment
Your clinician should involve you (and significant others as much as you want them to be) in the decisions around your care. You should expect your clinician to communicate with you in a way that is understandable for you. Your clinician should encourage you to take action regarding your hearing condition. At the same time, they should ensure that they really understand your thoughts, feelings and needs so that your journey is driven by you, not by their own agenda. The use of some simple evidence-based tools such as those produced by the Ida Institute can be very helpful in ensuring you receive the most effective support.
What usually happens in the first appointment?
The appointment itself will start with taking your hearing history, which provides the audiologist with information about your hearing and general health. This also gives you an opportunity to share your story. Then the audiologist will take a look in your ears with an otoscope to check for any wax buildup or other problems that might prevent the test from going ahead.
The test itself is done in a quiet soundproofed booth or room. You wear either headphones or insert earphones (foam earplug-like headphones that are inserted into the ear canal), and you listen to sounds under the headphones while the audiologist sits at a machine called an audiometer. This machine controls the output sound, in a very precise way, so that the audiologist can control the exact pitch and volume of each sound they play, and direct it to one ear or the other. Your job is to indicate every time you hear a sound, usually by pressing a hand-held response button. The audiologist will reduce the volume of the tone until you can no longer detect the sound. The softest volume at which you can reliably detect the tone is called a hearing threshold. It is recorded on a graph called an audiogram. The audiologist will perform this same procedure for a range of different pitches of sound and in your left and right ear until the audiogram is complete.
In addition to tones, the audiologist may also present words or sentences to you and ask you to repeat the words. Your answers are scored by the clinician. Depending on how complex your hearing test it, the whole process can take anywhere from 10 minutes to over 30 minutes.
Sometimes the audiologist may also perform a test called tympanometry. This test measures the mobility of your eardrum and how well ventilated your middle ear space (behind the eardrum) is. This involves the audiologist placing a plug in your ear while the pressure is slightly increased and decreased. This test requires you to sit still, but doesn’t require any response from you and only takes a minute or so to complete.
At the end of the assessment, the clinician will explain the results and offer some recommendations on next steps. You will work together to set some goals, and have a discussion about what options are available that are a good fit for your needs.
In some clinics that also provide rehabilitation/device fitting, you may be offered device options, including a quote for services, that are suitable for your needs. If you agree to proceed with a device fitting on the day, and depending on the device selected, the clinician may take an ear impression to have an earmold made that precisely and comfortably can sit in your ear.
Remember, you do not need to agree to proceed with the recommendations provided to you on the day. You can take the time you need to make the informed decision that’s right for you.
Questions for your first audiology appointment
If you are reading this, you have probably already done a bit of background reading about hearing conditions, devices, funding options and types of hearing loss. Maybe you have already made an appointment for a hearing test with an audiologist or audiometrist. If so, you have no doubt learned a lot already, but part of that learning process is no doubt realising there are still so many questions you want to ask!
It’s really important that you feel confident to ask questions, and sometimes it helps to be prepared by writing them down before your appointment so you don’t forget. You can take a notebook with you to jot down responses or information or, if it’s easier, you can ask to use your phone to record your consultation.
Can I get a copy of my results or an explanation of my results in writing?
How can I learn more about my test result or my condition?
Do I really need this solution/service?
How likely is this solution/service to be successful?
What are the likely benefits and risks from this solution/service?
Are there simpler or alternative options?
What happens if I don’t do anything? Ask if it might get worse or better if you don’t act.
What are the costs? Costs can be financial, emotional or a cost of your time. Is there a cheaper or easier alternative?
What is the process of obtaining this solution/service? For example, how many appointments, for how long?
Can I trial the device(s) before purchasing or get a refund if it’s not working for me?
Are there other services/specialists outside of your clinic that might be useful in my situation?
Of course, you are always entitled to ask for clarification on anything that is not clear to you.
Finally, if a hearing device or other service is recommended, don’t feel pressured to make a decision on the day. Ask for a written quote, and be comfortable to seek a second opinion.
Tips for if you feel unsure
Knowledge is power – taking the first step towards seeking help for a hearing condition, or a suspected hearing condition, is a very good idea, even if you go no further at this point. Consider trying a hearing screening tool at the very least. These tests are quick, free, self-administered, and at least you will have more knowledge about your hearing than you did before.
If you then decide to go ahead and get a diagnostic test done by an audiologist, you will have a comprehensive picture of what your hearing is like at that point in time, and if you ever do decide to move further along the help-seeking pathway, you will be able to refer back to that baseline test. Your hearing may remain the same for many years, or it may slowly decline over time, so checking your hearing every six months or so is a good idea. Research tells us that the sooner you get help the better the long-term outcomes will be on your overall health, not just your communication abilities.
To help you reflect on the impact that your hearing may be having on you, you could consider completing the activities in Soundfair’s My Hearing Diary
Hearing aids can be very expensive, but the good news is, they are not the only solution and there are several funding options available that might apply to you.
If you feel that you are lacking in motivation to move forward beyond this point and seek help, or that you are being held back by factors you can’t quite pinpoint, it might help to try and identify what those factors are. There is a free tool available online through the Ida Institute. It can help you to understand your own feelings about whether or not you should act on your hearing condition. The tool prompts you to think about the pros and cons of either doing nothing about your hearing or acting on it.
While it is designed to be worked through in a clinical setting, it is actually a very simple exercise that you can do on your own. Just follow the instructions provided at the link above. There is a blank worksheet that you can print out, and a worked example to help you reflect on your own feelings and argue your own pros and cons. Doing so will really help you to identify what is driving your decisions. Identifying what it is that is holding you back might help you to find ways to move forward on the journey towards better hearing health.
Stigma occurs when we respond negatively towards someone. Specifically, this negative reaction happens because of a particular characteristic or trait that we think they have. We perceive this characteristic or trait to be a disadvantage. Stigma can be based on anything, including race, clothes, language, mental health, sexuality, physical abilities, and ageing. There are no limits to what can be stigmatised.
Stigma is harmful. It might mean people are denied jobs, excluded from certain activities, or treated rudely. It can spread as an unconscious and unhelpful value in society. Stigma can even be directed at the self (you) – this is called self-stigma. We might react negatively to ourselves because of a characteristic or trait that we have had all our lives, or one that we have just recently acquired. Self-stigma is uncomfortable and associated with poorer self-esteem, higher stress, greater shame, and a lack of faith in our abilities. We are less likely to seek help for a condition that is stigmatised, such as ageing, which means we can go for years without seeking advice or assistance.
Hearing conditions are stigmatised by some people, and stigma can have significant psychological effects. This is not universal! Many people see hearing conditions as just another part of the normal human experience, like wearing prescription glasses. However, some people do hold stigmatising attitudes towards hearing conditions specifically. Or they may stigmatise ageing more generally, and aging may be associated with hearing loss. It is important to acknowledge that this can be part of your experience. You might also notice that you hold some of these attitudes yourself. One very powerful negative outcome of self-directed stigma is feeling ashamed of your hearing condition.
It is important to address this stigma – from others or directed towards ourselves. Stigma makes it harder to get the help that you need and makes it more difficult to use the assistance that you are offered. You might avoid getting your hearing checked, you might refuse to wear hearing aids, and you might be reluctant to ask people to meet your needs. Stigma can also isolate you and prevent you making strong and meaningful contributions at home, at work, and to the lives of those closest to you. See our resource called ‘How can you break the stigma of hearing loss’ for ideas about overcoming stigma.
Break the stigma
Stigma occurs when we respond negatively towards someone. Specifically, this negative reaction happens because of a particular characteristic or trait that we think they have. We perceive this characteristic or trait to be a disadvantage. These sorts of beliefs are often built over a lifetime, and are often held unconsciously. People with disabilities can experience this sort of stigma because they are seen as ‘blemished’ or ‘broken’, and that doesn’t align with the ‘able-bodied’ ideology that is prevalent in many societies.
People with hearing conditions can also experience stigma related to ageism. Ageism is prejudice against old age. Hearing loss and hearing aids are often culturally connected with old age and a weakening of ability. So having a hearing loss can mean a person is hit with a double whammy of two stigmatised identities, related to both disability and ageing. It’s no wonder many people are reluctant to admit that their hearing is causing them difficulties, and put off seeking help for far too long. Like anything that signals that we may be different, we may be nervous about revealing this characteristic for fear of being discriminated against or judged unfairly. We may even be apprehensive about acknowledging it to ourselves. This is normal, but unfortunately, hiding is a process that just increases the stigma, making it a difficult cycle to break.
Stigma can be directed inward – called self-stigma. You may be directing negative views about hearing loss and/or ageing at yourself or avoiding getting help with your hearing because of self-stigma. The first thing you can do is to appreciate that stigma is a social phenomenon. Stigma doesn’t reside in one individual – it’s about how people relate to one another, and it involves labelling, discrimination and loss of status. It is not YOUR problem, in that sense, it’s society’s problem. You might not be able to change society’s views all on your own, but you can start with you. Building connections with people who don’t hold stigmatised views towards hearing conditions can help. It can be very empowering to be able to talk with people whose experience is a bit like yours. Stigmatising views about hearing conditions are not universal, and if that’s true, then it’s possible for you to let go of those beliefs yourself.
Another step you can take towards overcoming self-stigma is to take the plunge and get your hearing tested. Getting a hearing test means starting the journey towards treating your hearing condition, proving to yourself that your hearing is something to be valued and prioritised. Discuss it with your audiologist or doctor, tell others that you are having some hearing difficulties, instead of concealing it which only enhances those feelings of shame inadequacy.
